Further defining the potential for focal therapy

A study from investigators at M. D. Anderson Cancer Center has attempted to assess the likelihood of total eradication of prostate cancer in men with prostate cancer that is found in only one lobe of the prostate and who would  qualify for subtotal prostate ablation with controlled thermal energy using such techniques as cryoablation or high-intensity focused ultrasound.

Ward et al. examined radical prostatectomy (RP) specimens from 180 men with a unilaterally positive prostate biopsy to characterize the location, volume, and grade of each focus of tumor. Two treatment templates (known as “hemiprostate” and “hockey-stick” templates) were applied to every prostate cross-section.

The results of this study showed the following:

  • A single focus of cancer was the only tumor in 31/180 of the patients (17 percent).
  • Cancer was present in both lobes of the prostate in 149/180 specimens (83 percent) even though the original biopsy showed cancer in only one lobe.
  • The hemiprostate and hockey-stick treatment templates covered all tumor foci in 17 and 47 percent of the specimens, respectively.
  • Most cancers that did not fall within the template treatment fields defined by the hemiprostate and hockey-stick tempates were clinically insignificant tumors not identified by prostate biopsy (i.e., volume ≤ 0.5 ml, Gleason score ≤ 6).
  • Regional ablation would have successfully treated all clinically significant prostate tumors in 64 and 81 percent of patients using the hemiprostate or hockey-stick templates, respectively.
  • The hockey-stick template encompassed all dominant tumours (largest volume).

The authors concluded that, “Regionally targeted prostate ablation is capable of eradicating all dominant tumors and the vast majority of clinically significant tumors in men with unilateral disease by biopsy.”

It is clear to The “New” Prostate Cancer InfoLink that the potential for focal therapy is gradually becoming better defined. We do not yet believe that such therapy is “ready for prime time.” At best it is investigtional and some would argue that it is still experimental. There is a very apparent need for a series of well constructed, preferably multi-center clinical trials to explore the real short, medium, and long term outcomes of such forms of focal therapy. Clinical responses to such treatment as well as patient satisfaction and adverse results all need to be very carefully tracked in such trials, and highly defined eligibility criteria are going to be essential.

One Response

  1. Hopefully, the ongoing focal cryo clinical trial at the Memorial Sloan-Kettering Cancer Center will show beneficial outcomes.

    The trial is still recruiting. Those diagnosed with low risk prostate cancer who are unwilling to accept the risks associated with mainstream treatment but who don’t like living with active surveillance should have a look at >the trial protocol.

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